LUIS HENRIQUE WOLFF GOWDAK
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
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- 3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY(2017) GUALANDRO, D. M.; YU, P. C.; CARAMELLI, B.; MARQUES, A. C.; CALDERARO, D.; FORNARI, L. S.; PINHO, C.; FEITOSA, A. C. R.; POLANCZYK, C. A.; ROCHITTE, C. E.; JARDIM, C.; VIEIRA, C. L. Z.; NAKAMURA, D. Y. M.; IEZZI, D.; SCHREEN, D.; ADAM, Eduardo L.; D'AMICO, E. A.; LIMA, M. Q.; BURDMANN, E. A.; PACHON, E. I. M.; BRAGA, F. G. M.; MACHADO, F. S.; PAULA, F. J.; CARMO, G. A. L.; FEITOSA-FILHO, G. S.; PRADO, G. F.; LOPES, H. F.; FERNANDES, J. R. C.; LIMA, J. J. G.; SACILOTTO, L.; DRAGER, L. F.; VACANTI, L. J.; ROHDE, L. E. P.; PRADA, L. F. L.; GOWDAK, L. H. W.; VIEIRA, M. L. C.; MONACHINI, M. C.; MACATRAO-COSTA, M. F.; PAIXAO, M. R.; OLIVEIRA JR., M. T.; CURY, P.; VILLACA, P. R.; FARSKY, P. S.; SICILIANO, R. F.; HEINISCH, R. H.; SOUZA, R.; GUALANDRO, S. F. M.; ACCORSI, T. A. D.; MATHIAS JR., W.
- Recurrent pulmonary edema caused by chronic left main coronary artery occlusion(2012) BITTENCOURT, M. S.; OLIVEIRA, A. L. V. De; GOWDAK, L. H. W.; CESAR, L. A. M.
article 1 Citação(ões) na Scopus The role of optimal medical therapy in patients with refractory angina(2017) GOWDAK, L. H. W.The management of patients with refractory angina poses a major clinical challenge. Optimal medical therapy (OMT) is of paramount importance to improving quality of life by reducing (as much as possible) the number of angina attacks with a correspondent increase in exercise tolerance. For that, a judicious use of a combination of all agents currently approved in the management of patients with stable angina should be implemented. Guidelines usually recommend a combination of hemodynamic agents, such as β-blockers, calcium-channel blockers, and/or long-acting nitrates, at maximally tolerated doses, followed by the addition (as needed) of antianginal agents with different modes of action, such as trimetazidine, ivabradine, ranolazine, nicorandil, perhexiline, allopurinol, and/or fasudil (where available). Here, we describe the case of a patient who initially received a diagnosis of refractory angina and in whom OMT greatly helped to improve symptoms.conferenceObject Obstructive Sleep Apnea Is Extremely Common And Associated With Myocardial Ischemia In Patients With Refractory Angina(2014) GEOVANINI, G. R.; PEREIRA, A. C.; GOWDAK, L. H. W.; DOURADO, L. O.; POPPI, N.; CESAR, L. M.; DRAGER, L. F.; LORENZI-FILHO, G.conferenceObject Cardiac rehabilitation in patients with refractory angina: preliminary results(2019) DOURADO, L.; ASSUMPCAO, C. R. A. A.; JORDAO, C. P.; VIEIRA, M. L. C.; GOWDAK, L. H. W.; CESAR, L. A. M.; MATOS, L. D. N. J.article 6 Citação(ões) na Scopus Prevalence of refractory angina in clinical practice(2017) GOWDAK, L. H. W.According to the American Heart Association, an estimated 15.5 million Americans aged 20 years and over have coronary artery disease, and 8.2 million are living with angina pectoris. Despite enormous advances in medical therapy and myocardial revascularization procedures, a growing number of patients will present with disabling symptoms due to myocardial ischemia, in whom a combination of classic antianginal drugs and angioplasty or bypass surgery is ineffective in providing symptom relief. Those patients are usually referred to as having refractory angina. They usually suffer from poor self-perceived health status, have significant impairments in quality of life with a high incidence of depression, and represent a burden to the health care system due to significant resource utilization, including rehospitalization. Because of the variability in defining unsuitability for revascularization and the use of different medical strategies for symptom control, and with only limited clinical data available from small, observational studies, a precise estimate of the prevalence of refractory angina is not available. Nevertheless, its incidence has been estimated at between 5% and 15% of patients undergoing cardiac catheterization. Presently, the incidence of newly diagnosed patients with refractory angina in the United States is something between 50 000 to 100 000 per year. In Europe, the incidence is estimated to be at least 30 000 to 50 000 new cases per year. Because life expectancy is increasing worldwide, the number of patients who will fulfill the criteria for refractory angina is expected to increase as well.conferenceObject Blood pressure level imposes different cardiovascular risk on renal transplant candidates in the presence of previous stroke or myocardial infarction(2013) GOWDAK, L. H. W.; PAULA, F. J. De; CESAR, L. A. M.; BORTOLOTTO, L. A.; LIMA, J. J. G. DeconferenceObject Obstructive sleep apnoea is highly frequent in consecutive patients with refractory angina(2012) GEOVANINI, G.; DRAGER, L.; DOURADO, L. O. C.; POPPI, N. T.; PEREIRA, A. C.; GOWDAK, L. H. W.; LORENZI-FILHO, G.Purpose: Obstructive sleep apnoea (OSA) is common among patients with stable coronary artery disease and may contribute to poor cardiovascular outcome. OSA has not been investigated in patients with refractory angina, a debilitating condition characterized by persistent symptoms despite optimized medical therapy. Methods: Consecutive patients with multi-vessel coronary disease by angiography and refractory angina (severe ischemic symptoms that persist despite optimal medical therapy and whom coronary revascularization procedures are no longer feasible or helpful) were recruited from a specialized out patient clinic. Regardless of sleep complaints, all patients were evaluated by standard overnight polysomnography, symptoms of excessive daytime sleepiness by Epworth Sleepiness Scale (ESS) and one week diary of angina. Results: We evaluated 31 patients (18 males, age: 62±10y, body mass index: 29.8±4.5kg/m2). Co-morbidities were common (dyslipidemia 100%, hypertension 93% and diabetes 61%) and all patients presented persistent angina despite optimal anti-ischemic medical therapy and preserved systolic function (ejection fraction on echocardiography: 53±11%). Patients presented poor sleep quality, poor sleep efficiency (60±16%) and the prevalence of OSA (AHI>15) and severe OSA (AHI>30) was 71 and 55%, respectively. As compared with patients without OSA patients with OSA presented similar age, gender, BMI (28.2±5 vs. 30.4±4.5kg/m2, p=0.26) similar ESS (10±6 vs. 11±6), non-significant trend to higher frequency of diurnal (66 vs. 91%, p=0.13) and nocturnal angina (45 vs. 77%, p=0.10). Conclusions: This preliminary study showed a high frequency of OSA in consecutive patients with refractory angina. Traditional risk factors for OSA, including age, male gender and BMI did not discriminate patients with OSA. Non-significant trends to higher frequency of diurnal and nocturnal angina suggest that OSA may contribute to trigger angina symptoms.article 0 Citação(ões) na Scopus Focus on trimetazidine in acute coronary syndrome(2018) GOWDAK, L. H. W.>Trimetazidine is an anti-ischemic agent that acts at the cellular level by shifting the cardiac energy metabolism from ß-oxidation of free fatty acids to the more efficient glucose oxidation. In patients with an acute myocardial infarction (AMI) who are treated with thrombolysis and/or a percutaneous coronary intervention (PCI), ischemia-reperfusion injury may occur after reestablishing myocardial blood supply to an ischemic region. In animal models of ischemia-reperfusion injury, trimetazidine markedly reduced casein kinase and lactate dehydrogenase activities and decreased the infarct size. In patients with an AMI, trimetazidine reduced the rate of any form of reperfusion arrhythmias, more so with potentially life-threatening arrhythmias. In the EMPI-FR study (European Myocardial Infarction Project-Free Radicals), in the subset of patients not receiving thrombolysis assessed as per-protocol analysis, there was an 11.9% and 13.8% risk reduction in 35-day mortality and in-hospital mortality, respectively, in patients receiving trimetazidine. More recently, it was shown that trimetazidine, as an adjunctive therapy to PCI, reduced myocardial damage and preserved left ventricular function more than PCI alone. In a large registry of patients with AMI, the use of trimetazidine was associated with significant reductions in all-cause mortality and combined major adverse cardiac events (MACE), a finding that was confirmed in the first meta-analysis to report these benefits in patients with AMI treated with trimetazidine, showing a 67% risk reduction for MACE, which was defined as the composite of death, recurrent nonfatal MI, target vessel revascularization, coronary artery bypass graft, recurrence of angina, and/or hospitalization for heart failure. © 2018 Les Laboratoires Seriver. All rights reserved.article 0 Citação(ões) na Scopus Living with pain(2017) GOWDAK, L. H. W.